Journal of Pharmacy Management - Jan 2022

Journal of Pharmacy Management • Volume 38 • Issue 1 • January 2022 heart failure andmanage them? There's no reason that can't be done through community pharmacy and pharmacists working in primary care in the future. GB: Pharmacy Management have just inked a deal with Bradford University along the lines of trying to create a continuing connection with the university. In your service, how is liability insurance covered? AM: The pharmacists need to arrange that with their usual provider. We had a lot of conversations with CPW (Community Pharmacy Wales) early on about the costs, and in the end we came to the conclusion that it was the contractor's responsibility to put this in place and that the fee would reflect the fact that there was a higher risk, but we were prepared to revisit that if indemnity costs were found to be exceptionally high. I had one company with four pharmacies contact me to talk about it and then they rang their insurer who said that's fine, no fee, we’ll put it on so they didn't see that there was a very high risk. Undifferentiated diagnosis is recognized as a higher risk for prescribing, but remote prescribing is the highest. These pharmacists have the person in the pharmacy and they're assessing them. They're qualified. The range of things that they're seeing is relatively limited. And if they spot red flags, they're not managing that patient. We haven't seen a significant indemnity element to it. However, I guess it's going to depend on when things go wrong and themore people we have going through, the more likely that is to happen and when eventually it does happen, we may see a shift in indemnity cover. GB: In England the discussion that's havingmost traction, I think, is if you have a pharmacist who works for a GP practice. they will be covered as things stand. If they do exactly the same job 10 yards down the road, they won't be covered, and that creates inequity for the patient, because the amount of recourse they have would be limited by the insurance. So do we really want the indemnity cover that a patient can tap into to be determined by where they went to? AM: Yes, I can see the argument, because we have our community pharmacist prescribers working in 111, seeing a patient with a UTI, and then that same patient walks into her community pharmacy the next day, and it's a totally different situation. It's the same pharmacist with the same patient in the same condition. It doesn't quite ring true, does it? The pharmacists have that confidence that if they've seen a patient, they probably saved an appointment at the GP. So if a consultation ends in them sending the patient to the GP, it doesn't mean that they are creating any additional rather, it's a failure to reduce demand. And the conversations I've hadwith colleagues is how important it is to get feedback from the GPs to the pharmacists. If the pharmacists send somebody to the GP that they didn't feel they needed to see that GP needs to explain to the pharmacist what their take is on the case so the pharmacist can understand why that patient didn't need to see them. Now sometimes it'll be a case of the pharmacist saying “I wouldn't have known what you've just said to me, because I don't have full access to their notes. I would always refer in that case because I can't do what you can do,” but sometimes it might be “OK, I've learned something. I’ll take that on board and I'll do something different next time.” GB: How does record-keeping work? AM: With the exception of a few pharmacists in North Wales, I'm pretty sure I'm right in saying that all the pharmacists providing the service in Wales have access to at least the summary care record for the patient . Choose Pharmacy is our main platform, and there is amodule in there for independent prescribing. It's very basic, but it does give them the opportunity to record the detail of a consultation and the prescription, and it gives them access to the Welsh GP Record, and some of the pharmacists in Wales have a direct log-in to their local practice vi a remote EMIS or Vision Anywhere . I have a group here who us e Adastra , which is what we have in out of hours, and they’re able to use that to print prescriptions, and it's a more sophisticated clinical system so it does interaction checking on prescriptions but it has limitations like no access to the Welsh Demographics Service, or the Welsh GP Record. But the feedback from them is that they very much value that system and they want to carry on using it as long as they can. They don't want to go onto the Choose Pharmacy system because it's a more basic system in many respects. 32